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Optic neuritis is not a single disease entity. It can occur as part of multiple sclerosis, neuromyelitis optica spectrum disorder, MOG-antibody disease or other inflammatory disorders, and the treatment implications differ. This 2024 evidence review summarises contemporary diagnosis and management, including the role of MRI and disease-specific antibody testing. A key practical message is that atypical optic neuritis—such as severe bilateral disease, prominent disc swelling, unusual age or poor recovery—should trigger consideration of alternatives to typical MS-associated optic neuritis. High-dose corticosteroids remain central to acute treatment, while plasma exchange is considered when recovery is inadequate in severe inflammatory cases. The review also highlights that long-term relapse prevention depends on identifying the underlying disorder correctly. For HCPs, an apparent optic neuritis diagnosis should therefore trigger careful phenotyping rather than automatic labelling as MS. Accurate distinction between MS, NMOSD and MOGAD can determine prognosis, acute treatment intensity and maintenance therapy. The topic fits IANCON's dedicated neuro-ophthalmology workshop and its emphasis on visual field interpretation, OCT, pupils and neuro-ophthalmic signs in special scenarios.
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Optic neuritis is not a single disease entity. It can occur as part of multiple sclerosis, neuromyelitis optica spectrum disorder, MOG-antibody disease or other inflammatory disorders, and the treatment implications differ. This 2024 evidence review summarises contemporary diagnosis and management, including the role of MRI and disease-specific antibody testing. A key practical message is that atypical optic neuritis—such as severe bilateral disease, prominent disc swelling, unusual age or poor recovery—should trigger consideration of alternatives to typical MS-associated optic neuritis. High-dose corticosteroids remain central to acute treatment, while plasma exchange is considered when recovery is inadequate in severe inflammatory cases. The review also highlights that long-term relapse prevention depends on identifying the underlying disorder correctly. For HCPs, an apparent optic neuritis diagnosis should therefore trigger careful phenotyping rather than automatic labelling as MS. Accurate distinction between MS, NMOSD and MOGAD can determine prognosis, acute treatment intensity and maintenance therapy. The topic fits IANCON's dedicated neuro-ophthalmology workshop and its emphasis on visual field interpretation, OCT, pupils and neuro-ophthalmic signs in special scenarios.
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